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Percutaneous Cholecystostomy Catheter Removal and Incidence of Clinically Significant Bile Leaks: A Clinical Approach to Catheter Management

¹ All authors: Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St., White 270, Boston, MA 02114.

OBJECTIVE. We sought to determine the incidence of bile leaks upon removal of small-bore percutaneous cholecystostomy catheters and to evaluate clinical and imaging guidelines to ensure safe catheter removal.

MATERIALS AND METHODS. A retrospective evaluation of all gallbladder drainages performed over a 5-year period revealed 163 patients (range, 7–98 years) who underwent percutaneous cholecystostomy catheter placement. Medical records and imaging studies were reviewed to assess the events at catheter removal (e.g., inadvertent removal, controlled removal with cholangiography without tract imaging, or controlled removal with cholangiography with tract imaging) and the incidence of major and minor bile leaks.

RESULTS. The events at catheter removal were assessed in 66 patients. Group 1 was 45 patients whose catheters were removed after a minimum of approximately 3 weeks with a cholangiogram that established cystic and common duct patency and no imaging of the tract. Catheters were not removed until the patient recovered from acute illnesses that contributed to acalculous cholecystitis. Group 2 was 11 patients managed similarly to group 1 except that tract imaging was performed at catheter removal. Group 3 was 10 patients whose tubes came out inadvertently without cholangiogram or tract imaging. Two major (group 2 and group 3) and two minor (group 2) bile leaks occurred. No bile leaks occurred in group 1 (p = 0.006).

CONCLUSION. Major bile leaks occurred in 3% of patients, and minor leaks occurred with equal frequency. Tract imaging may not be necessary in patients with small-bore gallbladder catheters who have recovered from critical illness, show patent cystic and common ducts, and have had catheters for 3–6 weeks.

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